Pharmaceutical compositions of berberine with epa and dha, and methods thereof

ABSTRACT

The invention provides various novel compositions of berberine in combination with pharmacologically active EPA and DHA, and related methods of their use in treating various diseases or disorders. The pharmaceutical compositions of the invention are useful in treating and/or preventing various diseases or disorders, including metabolic diseases or disorders such as dyslipidemia, hyperglycemia, hypertriglyceridemia, hyperlipidemia, diabetic dyslipidemia, diabetic hyperlipidemia, dyslipidemia in statin-intolerance patients, diabetes, diabetic complications, hypercholesterolemia, or obesity. Additionally, the pharmaceutical compositions of the invention are useful in treating and/or preventing atherosclerosis, heart diseases, neurodegenerative diseases, inflammation, cancers, as well as various liver diseases or disorders, such as fatty liver, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, cholestatic liver diseases or graft-versus-host disease of the liver. Furthermore, the pharmaceutical compositions of the invention are useful in improving liver functions in chronic viral associated liver diseases and alcohol-related liver diseases.

PRIORITY CLAIMS AND RELATED PATENT APPLICATIONS

This application claims the benefit of priority, under 35 U.S.C. §120,from the U.S. designation of International Application No.PCT/CN2016/105294, filed on Nov. 10, 2016, which claims benefit ofpriority from U.S. Provisional Application Ser. No. 62/254,739, filed onNov. 13, 2015, the entire content of each of PCT/CN2016/105294 and Ser.No. 62/254,739 is incorporated herein by reference in its entirety forall purposes.

TECHNICAL FIELD OF THE INVENTION

The invention generally relates to novel compositions and methods ofpreparation and therapeutic use thereof. In particular, the inventionrelates to novel pharmaceutical compositions of berberine in combinationwith omega-3 fatty acids, e.g., eicosapentaenoic acid (EPA) and/ordocosahexaenoic acid (DHA), or esters thereof, and methods of their use.The pharmaceutical compositions of the invention are useful in treatingand/or preventing various diseases or disorders, including metabolicdiseases or disorders such as dyslipidemia, hyperglycemia,hypertriglyceridemia, hyperlipidemia, diabetic dyslipidemia, diabetichyperlipidemia dyslipidemia in statin-intolerance patients, diabetes,diabetic complications, hypercholesterolemia, or obesity. Additionally,the pharmaceutical compositions of the invention are useful in treatingand/or preventing atherosclerosis, heart diseases, neurodegenerativediseases, inflammation, cancers, as well as various liver diseases ordisorders, such as fatty liver, non-alcoholic fatty liver disease,non-alcoholic steatohepatitis, cholestatic liver diseases orgraft-versus-host disease of the liver. Furthermore, the pharmaceuticalcompositions of the invention are useful in improving liver functions inchronic viral associated liver diseases and alcohol-related liverdiseases.

BACKGROUND OF THE INVENTION

Dyslipidemia is a disorder of lipoprotein metabolism, includinglipoprotein overproduction (hyperlipidemia) or deficiency. Dyslipidemiasmay be manifested by elevation of the total cholesterol, the “bad”low-density lipoprotein cholesterol and the triglyceride concentrations,and a decrease in the “good” high-density lipoprotein cholesterolconcentration in the blood. Dyslipidemia comes under consideration inmany situations including diabetes, a common cause of dyslipidemia.

Hyperlipidemia (or hyperlipoproteinemia) is the most common form ofdyslipidemia. It is characterized by abnormally elevated levels of anyor all lipids and/or lipoproteins in the blood. Diagnosis is bymeasuring plasma levels of total cholesterol, triglyceride, andindividual lipoproteins. Treatment involves dietary changes, exercise,and lipid-lowering drugs. Hyperlipidemias are divided into primary andsecondary subtypes. Primary hyperlipidemia is usually due to geneticcauses (such as a mutation in a receptor protein), while secondaryhyperlipidemia arises due to other underlying causes such as diabetes.Lipid and lipoprotein abnormalities are regarded as a modifiable riskfactor for cardiovascular disease due to their influence onatherosclerosis.

Hyperglycemia (or high blood sugar) is a condition characterized by anexcessive amount of glucose circulates in the blood plasma.Hyperglycemia is a potentially serious condition if not treated in timesince ketoacidosis, a life-threatening condition, could occur and needsimmediate treatment. Chronic hyperglycemia causes injuries to the heartand is strongly associated with heart attacks and death in subjects withno coronary heart disease or history of heart failure.

Diabetes mellitus (or diabetes) is a disorder of metabolism. It hasbecome pandemic with an estimate of over 300 million people worldwideliving with diabetes today. Without effective prevention, this numberwill grow up to 500 million by 2030. There are three main types ofdiabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes.Among them, type 2 diabetes, is the most common form of diabetesaccounting for 90-95% of cases. Type 2 diabetes is characterized byimpaired insulin secretion, increased hepatic glucose production, anddecreased response of peripheral tissues to insulin, i.e., insulinresistance. Many therapeutic treatments are available for the managementof type 2 diabetes, but they are often accompanied by various sideeffects. An optimal therapy should be safe and include early initiationof combination drugs with complimentary mechanisms of action.

Despite persistent efforts and meaningful progress over the past decadesin the understanding and management of diabetes, people with diabetescontinue to have an increased risk of, and many do suffer from, a numberof serious complications inflicting the heart and blood vessels, eyes,kidneys, and nerves due to high blood glucose, high cholesterol, andhigh blood pressure. Cardiovascular diseases are the most common causeof death in people with diabetes. Diabetic nephropathy caused by damagesto small blood vessels in the kidney leads to decreased kidney functionor kidney failure altogether. Diabetic neuropathy is caused by damagesto the nerves throughout the body when blood glucose level and bloodpressure are too high. Most people with diabetes develop diabeticretinopathy causing reduced vision or blindness. Consistently highlevels of blood glucose, together with high blood pressure and highcholesterol, are the main causes of diabetic retinopathy. Despite thedevelopment of a number of anti-diabetic agents, there are significantunmet needs for therapeutics that can be used effectively for thetreatment and management of diabetic complications.

Metabolic syndrome is a term that refers to a group of risk factors thatoccur together (e.g., abdominal (central) obesity, elevated bloodpressure, elevated fasting plasma glucose, high serum triglycerides, andlow high-density cholesterol (HDL) levels). Metabolic syndrome has beendemonstrated to increase the risk of developing cardiovascular diseases,particularly heart failure, and diabetes. Studies have estimated thatthe prevalence of metabolic syndromes in the US to be around 34% in theadult population. While therapeutics are available, the first linetreatment is change of lifestyle. High-dose statins, recommended toreduce cardiovascular risks, have been linked to higher progression todiabetes, especially in patients with metabolic syndrome.

Cardiovascular disease (CV), often used interchangeably with the term‘heart disease’, refers to a range of conditions that affect the heartsuch as coronary artery disease, arrhythmias, congestive heart failure,cerebrovascular disease etc. Many forms of CV can be prevented ortreated with healthy lifestyle choices, by controlling conditions suchas atherosclerosis, high blood pressure, diabetes or obesity with averity of medicines such as antiplatelet drugs, anticoagulants,digitalis, angiotensin converting enzyme (ACE) inhibitors, betablockers, and LDL cholesterol-lowering agents etc. Due to thecomorbidity, patients often need to take multiple medicines, and itwould be desirable if one pill can target multiple abnormalities.

With demonstrated ability to prevent cardiovascular disease, statins areamong one of the most widely prescribed medications. Although statinsare generally well tolerated, statin intolerance occurs in some patientsand requires careful consideration. In addition, patients are sometimesconcerned about the potential risk of statins causing diabetes mellitus,cancer, and memory loss and often question whether they should continuewith their medication. For statin-intolerant patients, non-statinLDL-C-lowering drugs can be used; however, till the PCSK9 inhibitors areapproved, none of the approved drugs has been nearly as effective asstatins. Developing alternative and effective therapeutics for thesepatients is much needed.

Neurodegenerative disease is an umbrella term for a range of conditionsthat primarily affect the neurons in the human brain. Neurons are thebuilding blocks of the nervous system that includes the brain and spinalcord. Neurons normally don't reproduce or replace themselves when theybecome damaged or die. Examples of neurodegenerative diseases includeParkinson's, Alzheimer's, and Huntington's disease. Neurodegenerativediseases are incurable and debilitating conditions that result inprogressive degeneration and/or death of nerve cells. The unmet medicalneeds for neurodegenerative diseases desperately call for thedevelopment of effective therapeutics.

Cancer is a group of diseases involving abnormal cell growth with thepotential to invade or spread to other parts of the body. In 2012, about14 million new cases of cancer occurred globally. The most common typesof cancer include lung cancer, prostate cancer, colorectal cancer andstomach cancer for men, and breast cancer, colorectal cancer, lungcancer and cervical cancer for women. While many treatment options forcancer exist, including surgery, chemotherapy, radiation therapy,hormonal therapy, targeted therapy and palliative care, cancer remains atop health threat and is responsible for about 15% of all human deaths.

Fatty liver is a reversible condition wherein large vacuoles oftriglyceride fat accumulate in liver cells via the process of steatosis.Despite having multiple causes, fatty liver can be considered a singledisease that occurs worldwide in those with excessive alcohol intake andthe obese. Non-alcoholic fatty liver disease (NAFLD) is a form of fattyliver diseases that occurs when excessive fat is deposited in the liverof patients without excessive alcohol intake. NAFLD is generallyrecognized to be associated with metabolic syndrome such as insulinresistance, hypertension and obesity. NAFLD affects about a third of theadult population in developed countries. Non-alcoholic steatohepatitis(NASH) is the most extreme form of NAFLD with chronic inflammation thatcan lead to progressive fibrosis (scarring), cirrhosis, and eventualliver failure and death. NASH resembles alcoholic liver disease, butoccurs in people who drink little or no alcohol. A major feature of NASHis fat in the liver, along with inflammation and damage. Most peoplewith NASH, an often “silent” liver disease, feel well and are not awarethat they have a liver problem. Nevertheless, NASH can be severe and canlead to cirrhosis, when the liver is permanently damaged and scarred andno longer work properly.

Currently, there are no drugs approved for the treatment of NASH, whichoccurs in about a quarter of patients with NAFLD. The current standardof care for NASH involves weight loss and increased physical activities.NASH affects 2-5% of Americans and is becoming more common, possiblybecause of the greater number of Americans with obesity. In the past 10years, the rate of obesity has doubled in adults and tripled inchildren.

The therapeutics and methods currently available for the management ofdiseases or disorders such as diabetes, diabetic complications,dyslipidemia, obesity, metabolic syndromes, pre-diabetes, Heartdiseases, neurodegenerative diseases, NAFLD, NASH, muscle atrophy,inflammation and cancers are suboptimal. There remains an ongoing andurgent need for novel and improved therapeutics and methods to treatsuch diseases or disorders.

SUMMARY OF THE INVENTION

The invention is based in part on novel pharmaceutical compositions ofberberine in combination with omega-3 fatty acids, e.g., EPA and/or DHA,or esters thereof, and related methods of their use in treating and/orpreventing various diseases or disorders.

The pharmaceutical compositions of the invention can be utilized totreat various diseases or disorders, including lipid and glucosediseases or disorders such as dyslipidemia, hyperglycemia,hypertriglyceridemia, hyperlipidemia, diabetic dyslipidemia, diabetichyperlipidemia, dyslipidemia in statin-intolerance patients, diabetes,diabetic complications, hypercholesterolemia, obesity, metabolicsyndromes, pre-diabetes, heart diseases, neurodegenerative diseases,inflammation, and cancers as well as various liver diseases ordisorders, such as fatty liver, non-alcoholic fatty liver disease,non-alcoholic steatohepatitis, cholestatic liver diseases orgraft-versus-host disease of the liver.

In one aspect, the invention generally relates to a pharmaceuticalcomposition that includes: (a) berberine, or a pharmaceuticallyacceptable salt thereof; (b) one or both of eicosapentaenoic acid, or apharmaceutically acceptable ester thereof, and docosahexaenoic acid, ora pharmaceutically acceptable ester thereof; and (c) optionally apharmaceutically acceptable excipient, carrier, or diluent. Theberberine, or a pharmaceutically acceptable salt thereof, and the one orboth of eicosapentaenoic acid, or a pharmaceutically acceptable esterthereof, and docosahexaenoic acid, or a pharmaceutically acceptableester thereof, are present in amounts that, when administered to asubject, are sufficient to treat, prevent, or reduce one or morediseases or disorders selected from metabolic diseases or disorders,heart diseases or disorders, neurodegenerative diseases or disorders,inflammation, cancers and liver diseases or disorders, or a relatedcondition thereof in a mammal, including a human.

In another aspect, the invention generally relates to a unit dosage formof a pharmaceutical composition comprising BBR ranging from about 100 mgto about 300 mg and EPA/DHA ranging from about 100 mg to about 800 mgEPA/DHA.

In yet another aspect, the invention generally relates to a method fortreating, reducing, or preventing a disease or disorder. The methodincludes: administering to a subject in need thereof a pharmaceuticalcomposition comprising (a) berberine, in a therapeutically effectiveamount; (b) one or both of eicosapentaenoic acid, or a pharmaceuticallyacceptable ester thereof, and docosahexaenoic acid, or apharmaceutically acceptable ester thereof, in therapeutically effectiveamounts, and (c) optionally a pharmaceutically acceptable excipient,carrier, or diluent. The disease or disorder is selected from metabolicdiseases or disorders, heart diseases or disorders, neurodegenerativediseases or disorders, inflammation, cancers and liver diseases ordisorders, or a related condition thereof in a mammal, including ahuman.

In yet another aspect, the invention generally relates to a kitincluding: (i) berberine, or a pharmaceutically acceptable salt thereof;(ii) one or both of eicosapentaenoic acid, or a pharmaceuticallyacceptable ester thereof, and docosahexaenoic acid, or apharmaceutically acceptable ester thereof; (iii) one or more agent(s)selected from the group consisting of vitamin D, vitamin C, vitamin E,vitamin B12, vitamin A, benfotiamine, chromium picolinate and vanadium;and (iv) instructions for administering agents (i), (ii) and (iii) to apatient having or at risk of having one or more diseases or disordersselected from metabolic disorders, atherosclerosis, heart diseases,neurodegenerative diseases and liver diseases.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1. Glucose and lipid regulating mechanisms of action of BBR.

FIG. 2. BBR Bioavailability Improvement of C_(max).

FIG. 3. BBR Bioavailability Improvement of AUC_((0-t)).

FIG. 4. EPA Bioavailability Improvement.

FIG. 5. The plots of BBR plasma concentrations versus time curves indogs.

DEFINITIONS

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. General principles of organicchemistry, as well as specific functional moieties and reactivity, aredescribed in “Organic Chemistry”, Thomas Sorrell, University ScienceBooks, Sausalito: 2006.

Certain compounds of the present invention may exist in particulargeometric or stereoisomeric forms. The present invention contemplatesall such compounds, including cis- and trans-isomers, R- andS-enantiomers, diastereomers, (D)-isomers, (L)-isomers, the racemicmixtures thereof, and other mixtures thereof, as falling within thescope of the invention. Additional asymmetric carbon atoms may bepresent in a substituent such as an alkyl group. All such isomers, aswell as mixtures thereof, are intended to be included in this invention.

Isomeric mixtures containing any of a variety of isomer ratios may beutilized in accordance with the present invention. For example, whereonly two isomers are combined, mixtures containing 50:50, 60:40, 70:30,80:20, 90:10, 95:5, 96:4, 97:3, 98:2, 99:1, or 100:0 isomer ratios arecontemplated by the present invention. Those of ordinary skill in theart will readily appreciate that analogous ratios are contemplated formore complex isomer mixtures.

If, for instance, a particular enantiomer of a compound of the presentinvention is desired, it may be prepared by asymmetric synthesis, or byderivation with a chiral auxiliary, where the resulting diastereomericmixture is separated and the auxiliary group cleaved to provide the puredesired enantiomers. Alternatively, where the molecule contains a basicfunctional group, such as amino, or an acidic functional group, such ascarboxyl, diastereomeric salts are formed with an appropriateoptically-active acid or base, followed by resolution of thediastereomers thus formed by fractional crystallization orchromatographic methods well known in the art, and subsequent recoveryof the pure enantiomers.

Given the benefit of this disclosure, one of ordinary skill in the artwill appreciate that synthetic methods, as described herein, may utilizea variety of protecting groups. By the term “protecting group”, as usedherein, it is meant that a particular functional moiety, e.g., O, S, orN, is temporarily blocked so that a reaction can be carried outselectively at another reactive site in a multifunctional compound. Inpreferred embodiments, a protecting group reacts selectively in goodyield to give a protected substrate that is stable to the projectedreactions; the protecting group should be selectively removable in goodyield by preferably readily available, non-toxic reagents that do notattack the other functional groups; the protecting group forms an easilyseparable derivative (more preferably without the generation of newstereogenic centers); and the protecting group has a minimum ofadditional functionality to avoid further sites of reaction. Oxygen,sulfur, nitrogen, and carbon protecting groups may be utilized. Examplesof a variety of protecting groups can be found in Protective Groups inOrganic Synthesis, Third Ed. Greene, T. W. and Wuts, P. G., Eds., JohnWiley & Sons, New York: 1999.

It will be appreciated that the compounds, as described herein, may besubstituted with any number of substituents or functional moieties.Throughout the specifications, groups and substituents thereof may bechosen to provide stable moieties and compounds.

As used herein, the term “effective amount” of an active agent refers toan amount sufficient to elicit the desired biological response. As willbe appreciated by those of ordinary skill in this art, the effectiveamount of a compound of the invention may vary depending on such factorsas the desired biological endpoint, the pharmacokinetics of thecompound, the disease being treated, the mode of administration, and thepatient.

As used herein, the term “treating, reducing, or preventing a disease ordisorder” refers to ameliorating such a condition before or after it hasoccurred. As compared with an equivalent untreated control, suchreduction or degree of prevention is at least 5%, 10%, 20%, 40%, 50%,60%, 80%, 90%, 95%, or 100% as measured by any standard technique.

As used herein, the term “pharmaceutically acceptable excipient,carrier, or diluent” refers to a pharmaceutically acceptable material,composition or vehicle, such as a liquid or solid filler, diluent,excipient, solvent or encapsulating material, involved in carrying ortransporting the subject pharmaceutical agent from one organ, or portionof the body, to another organ, or portion of the body. Each carrier mustbe “acceptable” in the sense of being compatible with the otheringredients of the formulation and not injurious to the patient. Someexamples of materials which can serve as pharmaceutically-acceptablecarriers include: sugars, such as lactose, glucose and sucrose;starches, such as corn starch and potato starch; cellulose, and itsderivatives, such as sodium carboxymethyl cellulose, ethyl cellulose andcellulose acetate; powdered tragacanth; malt; gelatin; talc; excipients,such as cocoa butter and suppository waxes; oils, such as peanut oil,cottonseed oil, safflower oil, sesame oil, olive oil, corn oil andsoybean oil; glycols, such as propylene glycol; polyols, such asglycerin, sorbitol, mannitol and polyethylene glycol; esters, such asethyl oleate and ethyl laurate; agar; buffering agents, such asmagnesium hydroxide and aluminum hydroxide; alginic acid; pyrogen-freewater; isotonic saline; Ringer's solution; ethyl alcohol; phosphatebuffer solutions; and other non-toxic compatible substances employed inpharmaceutical formulations. Wetting agents, emulsifiers and lubricants,such as sodium lauryl sulfate, magnesium stearate, and polyethyleneoxide-polypropylene oxide copolymer as well as coloring agents, releaseagents, coating agents, sweetening, flavoring and perfuming agents,preservatives and antioxidants can also be present in the compositions.

As used herein, the terms “isolated” or “purified” refer to a materialthat is substantially or essentially free from components that normallyaccompany it in its native state. Purity and homogeneity are typicallydetermined using analytical chemistry techniques such as polyacrylamidegel electrophoresis or high performance liquid chromatography.

As used herein, the term “subject” refers to any animal (e.g., amammal), including, but not limited to humans, non-human primates,rodents, and the like, which is to be the recipient of a particulartreatment. Typically, the terms “subject” and “patient” are usedinterchangeably herein in reference to a human subject.

As used herein, the “an amount sufficient” refers to the amount of acompound, alone or in combination with another therapeutic regimen,required to treat, prevent, or reduce a metabolic disorder such asdiabetes in a clinically relevant manner. A sufficient amount of anactive compound used to practice the present invention for therapeutictreatment of conditions caused by or contributing to diabetes variesdepending upon the manner of administration, the age, body weight, andgeneral health of the mammal or patient. Ultimately, the prescriberswill decide the appropriate amount and dosage regimen. Additionally, aneffective amount may be an amount of compound in the combination of theinvention that is safe and efficacious in the treatment of a patienthaving a metabolic disorder such as diabetes over each agent alone asdetermined and approved by a regulatory authority (such as the U.S. Foodand Drug Administration).

As used herein, the “low dosage” refers to at least 5% less (e.g., atleast 10%, 20%, 50%, 80%, 90%, or even 95%) than the lowest standardrecommended dosage of a particular compound formulated for a given routeof administration for treatment of any human disease or condition. Forexample, a low dosage of an agent that reduces glucose levels and thatis formulated for administration by inhalation will differ from a lowdosage of the same agent formulated for oral administration.

As used herein, the “high dosage” is meant at least 5% (e.g., at least10%, 20%, 50%, 100%, 200%, or even 300%) more than the highest standardrecommended dosage of a particular compound for treatment of any humandisease or condition.

Isotopically-labeled compounds are also within the scope of the presentdisclosure. As used herein, an “isotopically-labeled compound” refers toa presently disclosed compound including pharmaceutical salts andprodrugs thereof, each as described herein, in which one or more atomsare replaced by an atom having an atomic mass or mass number differentfrom the atomic mass or mass number usually found in nature. Examples ofisotopes that can be incorporated into compounds presently disclosedinclude isotopes of hydrogen, carbon, nitrogen, oxygen, phosphorous,fluorine and chlorine, such as ²H, ³H, ¹³C, ¹⁴C, ¹⁵N, ¹⁸O, ¹⁷O, ³¹P,³²P, ³⁵S, ¹⁸F, and ³⁶Cl, respectively.

By isotopically-labeling the presently disclosed compounds, thecompounds may be useful in drug and/or substrate tissue distributionassays. Tritiated (³H) and carbon-14 (¹⁴C) labeled compounds areparticularly preferred for their ease of preparation and detectability.Further, substitution with heavier isotopes such as deuterium (²H) canafford certain therapeutic advantages resulting from greater metabolicstability, for example increased in vivo half-life or reduced dosagerequirements and, hence, may be preferred in some circumstances.Isotopically labeled compounds presently disclosed, includingpharmaceutical salts, esters, and prodrugs thereof, can be prepared byany means known in the art.

Further, substitution of normally abundant hydrogen (¹H) with heavierisotopes such as deuterium can afford certain therapeutic advantages,e.g., resulting from improved absorption, distribution, metabolismand/or excretion (ADME) properties, creating drugs with improvedefficacy, safety, and/or tolerability. Benefits may also be obtainedfrom replacement of normally abundant ¹²C with ¹³C. See, WO 2007/005643,WO 2007/005644, WO 2007/016361, and WO 2007/016431.

Stereoisomers (e.g., cis and trans isomers) and all optical isomers of apresently disclosed compound (e.g., R and S enantiomers), as well asracemic, diastereomeric and other mixtures of such isomers are withinthe scope of the present disclosure.

Compounds of the present invention are, subsequent to their preparation,preferably isolated and purified to obtain a composition containing anamount by weight equal to or greater than 95% (“substantially pure”),which is then used or formulated as described herein. In certainembodiments, the compounds of the present invention are more than 99%pure.

Solvates and polymorphs of the compounds of the invention are alsocontemplated herein. Solvates of the compounds of the present inventioninclude, for example, hydrates.

Possible formulations include those suitable for oral, sublingual,buccal, parenteral (for example subcutaneous, intramuscular, orintravenous), rectal, topical including transdermal, intranasal andinhalation administration. Most suitable means of administration for aparticular patient will depend on the nature and severity of the diseaseor condition being treated or the nature of the therapy being used andon the nature of the active compound.

DETAILED DESCRIPTION OF THE INVENTION

The invention provides various novel compositions of berberine incombination with omega-3 fatty acids, e.g., EPA and/or DHA, or estersthereof, and related methods of their use in treating and/or preventingvarious diseases or disorders.

A key feature of the invention is the unique and synergisticpharmacological effects and reduction of side effects given rise (1) byberberine, which increases the bioavailability and reduces the risk ofcertain side effects of EPA and/or DHA, or esters thereof, and (2) byEPA and/or DHA, or esters thereof, which significantly improves thebioavailability of berberine. The carefully chosen dosages of each ofthese agents in the pharmaceutical composition provide the optimizedoverall therapeutic benefits to patients. Thus, for the first time, asingle pharmaceutical composition can effectively address two or morediseases and disorders, for examples, dyslipidemia and hyperglycemia.

Diseases and disorders that may be treated and/or prevented by thepharmaceutical compositions and methods disclosed herein includemetabolic diseases or disorders such as dyslipidemia, hyperglycemia,hypertriglyceridemia, hyperlipidemia, diabetic dyslipidemia, diabetichyperlipidemia, dyslipidemia in statin-intolerance patients, diabetes,diabetic complications, hypercholesterolemia, obesity, metabolicsyndromes or pre-diabetes, heart diseases, neurodegenerative diseases,inflammation, and cancers as well as various liver diseases ordisorders, such as fatty liver, non-alcoholic fatty liver disease,non-alcoholic steatohepatitis, cholestatic liver diseases orgraft-versus-host disease of the liver. The compounds of this inventionare also useful in improving liver functions in chronic viral associatedliver diseases and alcohol-related liver diseases.

In one aspect, the invention generally relates to a pharmaceuticalcomposition that includes: (a) berberine, or a pharmaceuticallyacceptable salt thereof; (b) one or both of eicosapentaenoic acid, or apharmaceutically acceptable ester thereof, and docosahexaenoic acid, ora pharmaceutically acceptable ester thereof; and (c) optionally apharmaceutically acceptable excipient, carrier, or diluent. Theberberine, or a pharmaceutically acceptable salt thereof, and the one orboth of eicosapentaenoic acid, or a pharmaceutically acceptable esterthereof, and docosahexaenoic acid, or a pharmaceutically acceptableester thereof, are present in amounts that, when administered to asubject, are sufficient to treat, prevent, or reduce one or morediseases or disorders selected from metabolic diseases or disorders,heart diseases or disorders, neurodegenerative diseases or disorders,sarcopenia, muscle atrophy, inflammation, cancers and liver diseases ordisorders, or a related condition thereof in a mammal, including ahuman.

Berberine(5,6-dihydro-9,10-dimethoxybenzo[g]-1,3-benzodioxolo[5,6-a]quinolizinium),an isoquinoline alkaloid isolated from Rhizoma Coptidis, has had a longhistory of medicinal use in China to treat various gastrointestinaldiseases. Berberine is found in a variety of plants as Berberis,Hydrastis canadensis, Xanthorhiza simplicissima, Phellodendron amurense,Coptis chinensis, Tinospora cordifolia, Argemone mexicana, andEschscholzia californica. In the past two decades, in vitro and in vivostudies have demonstrated the efficacy of berberine when used alone oras a combination for diabetes, dyslipidemia, cancer, neuroprotection andcardiovascular diseases. FIG. 1 shows various berberine's glucose andlipid regulating mechanisms of action.

Currently, berberine can be obtained commercially in the form ofchloride, sulfate or tannate salt, with berberine hydrochloride havingbeen used in almost all previous studies. The low bioavailability ofberberine in the current available forms makes its applications for thetreatment of chronic and systemic disease very challenging.

In certain embodiments, the pharmaceutical composition includes both ofeicosapentaenoic acid, or a pharmaceutically acceptable ester thereof,and docosahexaenoic acid, or a pharmaceutically acceptable esterthereof.

Eicosapentaenoic acid (EPA or(5Z,8Z,11Z,14Z,17Z)-5,8,11,14,17-icosapentaenoic acid), anddocosahexaenoic acid (DHA,4Z,7Z,10Z,13Z,16Z,19Z)-docosa-4,7,10,13,16,19-hexaenoic acid), are twobest-investigated omega-3 polyunsaturated fatty acids.

EPA is the active molecule in three FDA-approvedanti-hypertriglyceridemic agents. It has been demonstrated that EPA andDHA can reduce free fatty acid and triglyceride synthesis and increasetheir disposal. Effects of EPA and DHA have also been demonstrated inreducing chronic inflammation, improving insulin resistance, maintainingheart and vascular health and reducing the risk of coronary heartdisease. In addition to EPA and DHA, many more omega-3 fatty acidsexisted in nature with a range of therapeutic benefits, include but notlimited to Docosapentaenoic acid (DPA), α-Linolenic acid (ALA),Eicosatrienoic acid (ETE) etc.

In certain embodiments, the pharmaceutical composition includes one ofeicosapentaenoic acid, or a pharmaceutically acceptable ester thereof,and docosahexaenoic acid, or a pharmaceutically acceptable esterthereof.

Other omega-3 fatty acids may also be used here in addition to or inplace of one or both of eicosapentaenoic acid and docosahexaenoic acid.For example, docosapentaenoic acid, α-Linolenic acid, eicosatrienoicacid, hexadecatrienoic acid, stearidonic acid, eicosatetraenoic acid,heneicosapentaenoic acid, tetracosapentaenoic acid andtetracosahexaenoic acid may be used in the pharmaceutical compositionberberine in addition to or in place of EPA and DHA.

In certain embodiments, the pharmaceutical composition further includesone or more agents selected from the group consisting of vitamin D,vitamin C, vitamin E, vitamin B12, vitamin A, benfotiamine, chromiumpicolinate and vanadium.

In certain embodiments, the disease or disorder is selected from lipidand glucose diseases or disorders.

In certain embodiments, the lipid and glucose disease or disorder isselected from dyslipidemia, hyperglycemia, hypertriglyceridemia,hyperlipidemia, diabetic dyslipidemia, diabetic hyperlipidemia,dyslipidemia in statin-intolerance patients.

In certain embodiments, the disease or disorder is type 1 or type 2diabetes.

In certain embodiments, the disease or disorder is diabetic neuropathy,diabetic nephropathy, diabetic retinopathy, or macrovascularcomplications comprising heart attacks, strokes or insufficiency inblood flow to legs.

In certain embodiments, the disease or disorder is a heart disease oratherosclerosis.

In certain embodiments, the disease or disorder is a neurodegenerativedisease.

In certain embodiments, the disease or disorder is selected from fattyliver, NAFLD and NASH.

In certain embodiments, the pharmaceutical composition includes apharmaceutically acceptable excipient, carrier, or diluent.

In certain embodiments, the pharmaceutically acceptable ester ofeicosapentaenoic acid is an ethyl ester of eicosapentaenoic acid and thepharmaceutically acceptable ester of docosahexaenoic acid is an ethylester of docosahexaenoic acid.

In certain embodiments, the pharmaceutical composition includes: (a)berberine, or a pharmaceutically acceptable salt thereof; (b) ethylester of eicosapentaenoic acid and ethyl ester of docosahexaenoic acid;and (c) a pharmaceutically acceptable excipient, carrier, or diluent.

As used herein, the term “pharmaceutically acceptable salt” refers toeither a pharmaceutically acceptable acid addition salt or apharmaceutically acceptable base addition salt of a currently disclosedcompound that may be administered without any resultant substantialundesirable biological effect(s) or any resultant deleteriousinteraction(s) with any other component of a pharmaceutical compositionin which it may be contained.

In certain embodiments, the pharmaceutically acceptable salt ofberberine may be selected from salts of berberine cation with anions ofchloride, bromide, iodide, sulfate, bisulfate, hemisulphate, nitrate,phosphate, acid phosphate, isonicotinate, acetate, lactate, salicylate,citrate, tartrate, pantothenate, bitartrate, ascorbate, succinate,tannate, maleate, gentisinate, fumarate, gluconate, glucaronate,saccharate, formate, benzoate, glutamate, etc.

In certain embodiments, the pharmaceutical composition includes BBR toEPA/DHA at a weight ratio of BBR to EPA/DHA from about 3:1 to about 1:8(e.g., from about 3:1 to about 1:5, from about 3:1 to about 1:3, fromabout 3:1 to about 1:2, from about 3:1 to about 1:1, from about 3:1 toabout 2:1, from about 2:1 to about 1:8, from about 2:1 to about 1:5,from about 2:1 to about 1:2, from about 2:1 to about 1:1, from about 1:1to about 1:8, from about 1:1 to about 1:5, from about 1:1 to about 1:3,from about 3.33:1 to about 1:3, about 3:1, about 2:1, about 1:1, about1:2, about 1:3).

As used herein, the term “pharmaceutically acceptable ester,” refers toesters that hydrolyze in vivo and include those that break down readilyin the human body to leave the parent compound or a salt thereof.Examples of particular esters include esters formed by an acid with asubstituted or unsubstituted aliphatic alcohol (R-OH, wherein R is aC₁-C₆ alkyl group), for example, an ethyl ester or a propyl ester.

In another aspect, the invention generally relates to a unit dosage formof a pharmaceutical composition comprising BBR ranging from about 100 mgto about 300 mg (e.g., about 100 mg to about 250 mg, about 100 mg toabout 200 mg, about 100 mg to about 150 mg, about 150 mg to about 300mg, about 200 mg to about 300 mg, about 250 mg to about 300 mg, about150 mg to about 250 mg) and EPA/DHA ranging from about 100 mg to about800 mg EPA/DHA (e.g., about 100 mg to about 700 mg, about 100 mg toabout 600 mg, about 100 mg to about 500 mg, about 100 mg to about 400mg, about 100 mg to about 300 mg, about 100 mg to about 200 mg, about200 mg to about 800 mg, about 300 mg to about 800 mg, about 400 mg toabout 800 mg, about 500 mg to about 800 mg, about 600 mg to about 800mg, about 700 mg to about 800 mg, about 250 mg to about 750 mg, about500 mg to about 750 mg).

In yet another aspect, the invention generally relates to a method fortreating, reducing, or preventing a disease or disorder. The methodincludes: administering to a subject in need thereof a pharmaceuticalcomposition comprising (a) berberine, in a therapeutically effectiveamount; (b) one or both of eicosapentaenoic acid, or a pharmaceuticallyacceptable ester thereof, and docosahexaenoic acid, or apharmaceutically acceptable ester thereof, in therapeutically effectiveamounts, and (c) optionally a pharmaceutically acceptable excipient,carrier, or diluent. The disease or disorder is selected from metabolicdiseases or disorders, heart diseases or disorders, neurodegenerativediseases or disorders, sarcopenia, muscle atrophy, inflammation, cancersand liver diseases or disorders, or a related condition thereof in amammal, including a human.

In certain embodiments of the method, the pharmaceutical compositionincludes both of eicosapentaenoic acid, or a pharmaceutically acceptableester thereof, and docosahexaenoic acid, or a pharmaceuticallyacceptable ester thereof

In certain embodiments of the method, the pharmaceutical compositionincludes one of eicosapentaenoic acid, or a pharmaceutically acceptableester thereof, and docosahexaenoic acid, or a pharmaceuticallyacceptable ester thereof.

In certain embodiments of the method, the pharmaceutical compositionfurther includes one or more agents selected from the group consistingof vitamin D, vitamin C, vitamin E, vitamin B12, vitamin A,benfotiamine, chromium picolinate and vanadium.

In certain embodiments of the method, the pharmaceutically acceptableester of eicosapentaenoic acid is an ethyl ester of eicosapentaenoicacid and the pharmaceutically acceptable ester of docosahexaenoic acidis an ethyl ester of docosahexaenoic acid.

In certain embodiments of the method, the pharmaceutical compositionincludes: (a) berberine, or a pharmaceutically acceptable salt thereof;(b) ethyl ester of eicosapentaenoic acid and ethyl ester ofdocosahexaenoic acid; and (c) a pharmaceutically acceptable excipient,carrier, or diluent.

In certain embodiments of the method, the pharmaceutically acceptablesalt of berberine is a chloride salt. In certain embodiments of themethod, the pharmaceutically acceptable salt of berberine is a sulfatesalt.

In certain embodiments of the method, the pharmaceutical compositionincludes BBR and EPA/DHA at a weight ratio of BBR to EPA/DHA from about3:1 to about 1:8 (e.g., from about 3:1 to about 1:5, from about 3:1 toabout 1:3, from about 3:1 to about 1:2, from about 3:1 to about 1:1,from about 3:1 to about 2:1, from about 2:1 to about 1:8, from about 2:1to about 1:5, from about 2:1 to about 1:2, from about 2:1 to about 1:1,from about 1:1 to about 1:8, from about 1:1 to about 1:5, from about 1:1to about 1:3, from about 3.33:1 to about 1:3, about 3:1, about 2:1,about 1:1, about 1:2, about 1:3).

In certain embodiments, the method includes administering a unit dosageform comprising BBR in about 100 mg to about 300 mg (e.g., about 100 mgto about 250 mg, about 100 mg to about 200 mg, about 100 mg to about 150mg, about 150 mg to about 300 mg, about 200 mg to about 300 mg, about250 mg to about 300 mg, about 150 mg to about 250 mg) and EPA/DHA inabout 100 mg to about 800 mg (e.g., about 100 mg to about 700 mg, about100 mg to about 600 mg, about 100 mg to about 500 mg, about 100 mg toabout 400 mg, about 100 mg to about 300 mg, about 100 mg to about 200mg, about 200 mg to about 800 mg, about 300 mg to about 800 mg, about400 mg to about 800 mg, about 500 mg to about 800 mg, about 600 mg toabout 800 mg, about 700 mg to about 800 mg, about 250 mg to about 750mg, about 500 mg to about 750 mg). In certain embodiments of the method,the unit dosage form is a soft gel capsule. In certain embodiments ofthe method, the unit dosage form is administered from once, twice orthree times daily.

In certain embodiments of the method, the disease or disorder isselected from lipid and glucose diseases or disorders. In certainembodiments of the method, the lipid and glucose disease or disorder isselected from dyslipidemia, hyperglycemia, hypertriglyceridemia,hyperlipidemia, diabetic dyslipidemia, diabetic hyperlipidemia,dyslipidemia in statin-intolerance patients. In certain embodiments ofthe method, the disease or disorder is type 1 or type 2 diabetes. Incertain embodiments of the method, the disease or disorder is diabeticneuropathy, diabetic nephropathy, diabetic retinopathy, or macrovascularcomplications comprising heart attacks, strokes or insufficiency inblood flow to legs. In certain embodiments of the method, the disease ordisorder is a heart disease or atherosclerosis. In certain embodimentsof the method, the disease or disorder is a neurodegenerative disease.In certain embodiments of the method, the disease or disorder isselected from fatty liver, NAFLD and NASH.

In certain embodiments of the method, treating, reducing, or preventinga disease or disorder is by reducing blood glucose levels of thesubject. In certain embodiments of the method, treating, reducing, orpreventing a disease or disorder is by reducing total cholesterol (TC),triglyceride (TG) and low-density lipoprotein cholesterol (LDL-c)levels, increasing high-density lipoprotein cholesterol (HDL-c) levelsof the subject. In certain embodiments of the method, treating,reducing, or preventing a disease or disorder is by normalizing liverenzyme levels of the subject. In certain embodiments of the method,treating, reducing, or preventing a disease or disorder is by modulatinginsulin-signaling pathway such that glucose levels are reduced. Incertain embodiments of the method, treating, reducing, or preventing adisease or disorder is by regulating multiple metabolic pathways such asincreasing secretion of insulin, improving insulin sensitivity, reducinggluconeogenesis in liver, reducing glucose absorption, amelioratingdyslipidemia, anti-inflammation to achieve the desired pharmacologicaleffects.

In yet another aspect, the invention generally relates to a kitincluding: (i) berberine, or a pharmaceutically acceptable salt thereof;(ii) one or both of eicosapentaenoic acid, or a pharmaceuticallyacceptable ester thereof, and docosahexaenoic acid, or apharmaceutically acceptable ester thereof; (iii) one or more agent(s)selected from the group consisting of vitamin D, vitamin C, vitamin E,vitamin B12, vitamin A, benfotiamine, chromium picolinate and vanadium;and (iv) instructions for administering agents (i), (ii) and (iii) to apatient having or at risk of having one or more diseases or disordersselected from metabolic disorders, atherosclerosis, heart diseases,neurodegenerative diseases and liver diseases.

In certain embodiments of the kit, the pharmaceutically acceptable esterof eicosapentaenoic acid is an ethyl ester of eicosapentaenoic acid andthe pharmaceutically acceptable ester of docosahexaenoic acid is anethyl ester of docosahexaenoic acid. In certain embodiments of the kit,the pharmaceutically acceptable salt of berberine is a chloride salt. Incertain embodiments of the kit, the pharmaceutically acceptable salt ofberberine is a sulfate salt.

In certain preferred embodiments of the kit, the weight ratio of BBR toEPA/DHA from about 3:1 to about 1:8 (e.g., from about 3:1 to about 1:5,from about 3:1 to about 1:3, from about 3:1 to about 1:2, from about 3:1to about 1:1, from about 3:1 to about 2:1, from about 2:1 to about 1:8,from about 2:1 to about 1:5, from about 2:1 to about 1:2, from about 2:1to about 1:1, from about 1:1 to about 1:8, from about 1:1 to about 1:5,from about 1:1 to about 1:3, from about 3.33:1 to about 1:3, about 3:1,about 2:1, about 1:1, about 1:2, about 1:3). In certain embodiments, thekit includes about 100 mg to about 300 mg (e.g., about 100 mg to about250 mg, about 100 mg to about 200 mg, about 100 mg to about 150 mg,about 150 mg to about 300 mg, about 200 mg to about 300 mg, about 250 mgto about 300 mg, about 150 mg to about 250 mg) of BBR and about 100 mgto about 800 mg (e.g., about 100 mg to about 700 mg, about 100 mg toabout 600 mg, about 100 mg to about 500 mg, about 100 mg to about 400mg, about 100 mg to about 300 mg, about 100 mg to about 200 mg, about200 mg to about 800 mg, about 300 mg to about 800 mg, about 400 mg toabout 800 mg, about 500 mg to about 800 mg, about 600 mg to about 800mg, about 700 mg to about 800 mg, about 250 mg to about 750 mg, about500 mg to about 750 mg) of EPA/DHA.

The kit may be used for treating, reducing, or preventing a disease ordisorder, for example, by reducing blood glucose levels of the subject,by reducing total cholesterol (TC), triglyceride (TG) and low-densitylipoprotein cholesterol (LDL-c) levels, increasing high-densitylipoprotein cholesterol (HDL-c) levels of the subject, by normalizingliver enzyme levels of the subject, by modulating insulin-signalingpathway such that glucose levels are reduced, by regulating multiplemetabolic pathways such as increasing secretion of insulin, improvinginsulin sensitivity, reducing gluconeogenesis in liver, reducing glucoseabsorption, ameliorating dyslipidemia, anti-inflammation to achieve thedesired pharmacological effects.

The following examples are meant to be illustrative of the practice ofthe invention, and not limiting in any way.

EXAMPLES Example 1 Pharmacokinetic Properties of the Combination ofBerberine and EPA/DHA in Rats and Dogs

This example describes the in vivo studies in rats and dogs on thepharmacokinetic (PK) properties of the combination of berberine (BBR)and EPA and/or DHA disclosed in the present invention.

In the single-dose pharmacokinetics study in rats, after 7-dayacclimation, healthy male Sprague-Dawley (SD) rats with the body weightof 210-250 g were randomized into four groups as follows (3 rats pergroup).

Group Compositions Vehicle Control 0.5% gum tragacanth BerberineHydrochloride BBR•HCl 51.13 mg/Kg (BBR•HCl) EPA Ethylester (EPA-EE)EPA-EE 45.48 mg/Kg BBR + EPA-EE BBR•HCl 51.13 mg/Kg + EPA-EE 45.48 mg/Kg

The rats in each group were orally treated with the suspensions of thecorresponding testing articles indicated above in 0.5% gum tragacanthrespectively. Blood samples of the test animals were collected pre-doseand at the time points of 15 min, 30 min, 1 h, 1.5 h, 2 h, 4 h, 8 h, 24h post-dose. The collected blood samples (approximately 400 μL) wereplaced into tubes containing heparin sodium and centrifuged at 8,000 rpmfor 6 minutes at 4° C. to separate plasma. The obtained plasma from eachsample was stored at −80° C. until being analyzed.

Plasma concentrations of BBR and EPA were determined using tandem massspectrometry (LC-MS/MS) analysis. A non-compartmental module ofWinNonlin® Professional 5.2 (Pharsight; St. Louis Mo.), was used tocalculate PK parameters. The abbreviation AUC_((0-t)) represents areaunder the curve from the time of dosing to the time of the lastobservation, the AUC_((0-∞)) represents area under the curve from thetime of dosing to infinity, and the C_(max) represents maximumconcentration detected. The concentration-time curve and selected PKparameters are presented in Table 1 below.

TABLE 1 Select Pharmacokinetics Parameters of EPA (free acid) and BBR inSD Rats Following Single Oral Administration Analyte BBR EPA (Free acid)Dose Level AUC_((0-t)) AUC_((0-∞)) C_(max) AUC_((0-t)) AUC_((0-∞))C_(max) Group (mg/Kg) μg/L*hr μg/L*hr μg/L μg/L*hr μg/L*hr μg/L EPA45.48 — — — 3750.73 6600.31 629.38 BBR 51.13 7.46 8.84 0.95 — — — BBR +EPA − EE 51.13 + 45.48 28.06 37.46 6.67 4307.76 5214.47 635.15 Vehicle0.5% gum — — — 2708.52 7715.45 383.12 tragacanth

In another single-dose pharmacokinetics study in rats, after 7-dayacclimation, healthy male Sprague-Dawley (SD) rats with the body weightof 210-250 g were randomized into nine groups as follows (5 rats pergroup).

Group Compositions Vehicle Control 0.5% gum tragacanth EPA/DHAEPA-EE/DHA-EE 100 mg/Kg EPA/DHA EPA-EE/DHA-EE 300 mg/Kg EPA/DHAEPA-EE/DHA-EE 800 mg/Kg BBR BBR•HCl 100 mg/Kg BBR + EPA/DHA BBR•HCl 100mg/Kg + (1:0.3) EPA-EE/DHA-EE 30 mg/Kg BBR + EPA/DHA BBR•HCl 100 mg/Kg +(1:1) EPA-EE/DHA-EE 100 mg/Kg BBR + EPA/DHA BBR•HCl 100 mg/Kg + (1:3)EPA-EE/DHA-EE 300 mg/Kg BBR + EPA/DHA BBR•HCl 100 mg/Kg + (1:8)EPA-EE/DHA-EE 800 mg/Kg

The rats in each group were orally treated with the suspensions of thecorresponding testing articles indicated above in 0.5% gum tragacanthrespectively. Blood samples of the test animals were collected pre-doseand at the time points of 15 min, 30 min, 1 h, 1.5 h, 2 h, 4 h, 8 h, 24h post-dose. The collected blood samples (approximately 400 μL) wereplaced into tubes containing heparin sodium and centrifuged at 8,000 rpmfor 6 minutes at 4° C. to separate plasma. The obtained plasma from eachsample was stored at −80° C. until being analyzed.

Plasma concentrations of BBR and EPA were determined and PK parameterswere calculated. The concentration-time curve and selected PK parametersare presented in FIGS. 2-4 and Table 2 below.

TABLE 2 Selected Pharmacokinetics Parameters of BBR and EPA (free acid)in SD Rats Following Single Oral Administration Analyte BBR EPA (Freeacid) Dose Level AUC_((0-t)) AUC_((0-∞)) C_(max) AUC_((0-t)) AUC_((0-∞))C_(max) Group mg/Kg μg/L*hr μg/L*hr μg/L μg/L*hr μg/L*hr μg/L EPA/DHA100 — — — 8456.85 9563.27 1174.79 EPA/DHA 300 — — — 16254.39 19961.382384.25 EPA/DHA 800 — — — 25000.64 28530.44 4757.22 BBR + EPA/DHA 100 +30  49.14 NA 4.24 11045.10 13575.57 1479.70 (1:0.3) BBR + EPA/DHA 100 +100 58.83 108.47 6.17 14977.86 22622.02 1935.70 (1:1) BBR + EPA/DHA100 + 300 64.59 254.76 6.62 26970.51 NA 3717.06 (1:3) BBR + EPA/DHA100 + 800 100.29 107.95 15.58 33218.55 27208.42 3967.47 (1:8) Vehicle /— — — 10107.76

1271.59

indicates data missing or illegible when filed

In the single-dose pharmacokinetics study in dogs, six healthy malebeagle dogs weighing 9.95-11.45 Kg were randomized into two groups asfollows (3 dogs per group).

Group Compositions Hard capsule BBR•HCl 200 mg/capsule Softgel capsuleBBR•HCl 200 mg + fish oil/capsule

The dogs in each group were orally treated with corresponding testingarticles indicated above. Blood samples of the test animals werecollected pre-dose and at the time points of 15 min, 30 min, 1 h, 1.5 h,2 h, 4 h, 8 h, 24 h post-dose. Blood samples (approximately 400 ilL)were collected and placed into tubes containing heparin sodium andcentrifuged at 8000 rpm for 6 minutes at 4° C. to separate plasma. Theobtained plasma from each sample was stored at −80° C. until beinganalyzed.

Plasma concentrations of BBR were determined and PK parameters werecalculated. Following single oral administration of hard capsule (200 mgBBR/capsule), two out of three dogs' BBR plasma concentration of allcollection points was below the LLOQ (0.1 ng/mL); only one dog has ameasurable BBR plasma concentration with the C_(max) and AUC_((0-24h))of 0.42 ng/mL and 7.40 ng/mL*h respectively. Following single oraladministration of soft gel capsule (BBR +EPA-EE/DHA-EE), the mean valueof C_(max) and AUC_((0-24h)) were 8.67 ng/mL and 63.42 ng/mL*h,respectively. The concentration-time curve and selected PK parametersare presented in FIG. 5 and Table 3 below.

TABLE 3 Selected Pharmacokinetics Parameters of BBR in Beagle DogsFollowing Single Oral Administration BBR Analyte AUC_((0-t)) AUC_((0-∞))C_(max) Group Composition μg/L*hr μg/L*hr μg/L Softgel capsules BBR 200mg + fish oil 63.42 173.39 8.67 Hard capsules BBR 200 mg  7.4* NA* 0.42**Only one dog has measurable BBR plasma concentration

Above experimental results indicated that comparing to BBR or EPA/DHAadministering alone, the combination of BBR and EPA/DHA synergisticallyimprove each other's bioavailability as evidenced by the increase ofC_(max) and AUC. In all the tested combinations with different ratios ofBBR and EPA/DHA, the synergistic effect between BBR and EPA/DHA onbioavailability was observed. The increase of exposure level is impactedby the ratio of BBR and EPA/DHA; however, it is not strictlydose-dependent. The preferred ratios of BBR to EPA/DHA have been foundto be in the range from about 1:1 to about 1:3.

The results demonstrate that the combination of BBR and EPA/DHA providessignificantly improved pharmacokinetic properties. More specifically, inHFD/STZ induced diabetic dyslipidemia mouse model, comparing to BBR usedalone, the combination of BBR and EPA/DHA has been shown to effectively:Improve glucose homeostasis; reduce TC, TG and LDL-c in serum; reduceTC, TG in liver tissue; reduce elevated liver enzymes, and improve liverfunction; reduce oxidative stress of liver; reduce liver index; andimprove pancreas index.

In this specification and the appended claims, the singular forms “a,”“an,” and “the” include plural reference, unless the context clearlydictates otherwise.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art. Although any methods and materials similar or equivalent tothose described herein can also be used in the practice or testing ofthe present disclosure, the preferred methods and materials are nowdescribed. Methods recited herein may be carried out in any order thatis logically possible, in addition to a particular order disclosed.

Incorporation by Reference

References and citations to other documents, such as patents, patentapplications, patent publications, journals, books, papers, webcontents, have been made in this disclosure. All such documents arehereby incorporated herein by reference in their entirety for allpurposes. Any material, or portion thereof, that is said to beincorporated by reference herein, but which conflicts with existingdefinitions, statements, or other disclosure material explicitly setforth herein is only incorporated to the extent that no conflict arisesbetween that incorporated material and the present disclosure material.In the event of a conflict, the conflict is to be resolved in favor ofthe present disclosure as the preferred disclosure.

Equivalents

The representative examples disclosed herein are intended to helpillustrate the invention, and are not intended to, nor should they beconstrued to, limit the scope of the invention. Indeed, variousmodifications of the invention and many further embodiments thereof, inaddition to those shown and described herein, will become apparent tothose skilled in the art from the full contents of this document,including the examples which follow and the references to the scientificand patent literature cited herein. The following examples containimportant additional information, exemplification and guidance that canbe adapted to the practice of this invention in its various embodimentsand equivalents thereof

1. A pharmaceutical composition comprising: (a) berberine, or apharmaceutically acceptable salt thereof; (b) one or both ofeicosapentaenoic acid, or a pharmaceutically acceptable ester thereof,and docosahexaenoic acid, or a pharmaceutically acceptable esterthereof; and (c) optionally a pharmaceutically acceptable excipient,carrier, or diluent, wherein the berberine, or a pharmaceuticallyacceptable salt thereof, and the one or both of eicosapentaenoic acid,or a pharmaceutically acceptable ester thereof, and docosahexaenoicacid, or a pharmaceutically acceptable ester thereof, are present inamounts that, when administered to a subject, are sufficient to treat,prevent, or reduce one or more diseases or disorders selected frommetabolic diseases or disorders, heart diseases or disorders,neurodegenerative diseases or disorders, inflammation, cancers and liverdiseases or disorders, or a related condition thereof in a mammal,including a human.
 2. The pharmaceutical composition of claim 1,comprising both of eicosapentaenoic acid, or a pharmaceuticallyacceptable ester thereof, and docosahexaenoic acid, or apharmaceutically acceptable ester thereof.
 3. (canceled)
 4. Thepharmaceutical composition of claim 1, further comprising one or moreagents selected from the group consisting of vitamin D, vitamin C,vitamin E, vitamin B12, vitamin A, benfotiamine, chromium picolinate andvanadium.
 5. The pharmaceutical composition of claim 1, wherein thedisease or disorder is selected from lipid and glucose diseases ordisorders, is type 1 or type 2 diabetes, fatty liver, NAFLD and NASH. 6.(canceled)
 7. The pharmaceutical composition of claim 1, wherein thedisease or disorder is type 1 or type 2 diabetes.
 8. The pharmaceuticalcomposition of claim 1, wherein the disease or disorder is diabeticneuropathy, diabetic nephropathy, diabetic retinopathy, or macrovascularcomplications comprising heart attacks, strokes or insufficiency inblood flow to legs.
 9. The pharmaceutical composition of claim 1,wherein the disease or disorder is a heart disease or atherosclerosis ora neurodegenerative disease. 10-13. (canceled)
 14. The pharmaceuticalcomposition of claim 13, comprising (a) berberine, or a pharmaceuticallyacceptable salt thereof; (b) ethyl ester of eicosapentaenoic acid andethyl ester of docosahexaenoic acid; and (c) a pharmaceuticallyacceptable excipient, carrier, or diluent.
 15. The pharmaceuticalcomposition of claim 14, wherein the pharmaceutically acceptable salt ofberberine is a chloride salt or a sulfate salt.
 16. (canceled)
 17. Thepharmaceutical composition of claim 14, wherein the weight ratio of BBRto EPA/DHA is from about 3:1 to about 1:8.
 18. A unit dosage formcomprising a pharmaceutical composition of claim 1, wherein the unitdosage form comprises BBR ranging from about 100 mg to about 300 mg andEPA/DHA ranging from about 100 mg to about 800 mg.
 19. A method fortreating, reducing, or preventing a disease or disorder, comprisingadministering to a subject in need thereof a pharmaceutical compositioncomprising (a) berberine, in a therapeutically effective amount; (b) oneor both of eicosapentaenoic acid, or a pharmaceutically acceptable esterthereof, and docosahexaenoic acid, or a pharmaceutically acceptableester thereof, in therapeutically effective amounts, and (c) optionallya pharmaceutically acceptable excipient, carrier, or diluent, whereinthe disease or disorder is selected from metabolic diseases ordisorders, heart diseases or disorders, neurodegenerative diseases ordisorders, sarcopenia, muscle atrophy, inflammation, cancers and liverdiseases or disorders, or a related condition thereof in a mammal,including a human.
 20. (canceled)
 21. (canceled)
 22. The method of claim19, wherein the pharmaceutical composition further comprises one or moreagents selected from the group consisting of vitamin D, vitamin C,vitamin E, vitamin B12, vitamin A, benfotiamine, chromium picolinate andvanadium.
 23. (canceled)
 24. The method of claim 23, wherein thepharmaceutical composition comprises: (a) berberine, or apharmaceutically acceptable salt thereof; (b) ethyl ester ofeicosapentaenoic acid and ethyl ester of docosahexaenoic acid; and (c) apharmaceutically acceptable excipient, carrier, or diluent.
 25. Themethod of claim 24, wherein the pharmaceutically acceptable salt ofberberine is a chloride salt or a sulfate salt.
 26. (canceled)
 27. Themethod of claim 24, wherein the weight ratio of BBR to EPA/DHA is fromabout 3:1 to about 1:8.
 28. The method of claim 24, comprisingadministering a unit dosage form comprising about 100 mg to about 300 mgof BBR and about 100 mg to about 800 mg of EPA/DHA once, twice or threetimes daily.
 29. (canceled)
 30. (canceled)
 31. The method of claim 19,wherein the disease or disorder is selected from lipid and glucosediseases or disorders, type 1 or type 2 diabetes, diabetic neuropathy,diabetic nephropathy, diabetic retinopathy, or macrovascularcomplications comprising heart attacks, strokes or insufficiency inblood flow to legs, fatty liver, NAFLD and NASH. 32-34. (canceled) 35.The method of claim 19, wherein the disease or disorder is selected froma heart disease or atherosclerosis, or a neurodegenerative disease.36-42. (canceled)
 43. A kit comprising: (i) berberine, or apharmaceutically acceptable salt thereof; (ii) one or both ofeicosapentaenoic acid, or a pharmaceutically acceptable ester thereof,and docosahexaenoic acid, or a pharmaceutically acceptable esterthereof; (iii) optionally one or more agent(s) selected from the groupconsisting of vitamin D, vitamin C, vitamin E, vitamin B12, vitamin A,benfotiamine, chromium picolinate and vanadium; and (iv) instructionsfor administering agents (i), (ii) and (iii) to a patient having or atrisk of having one or more diseases or disorders selected from metabolicdisorders, atherosclerosis, heart diseases, neurodegenerative diseasesand liver diseases. 44-48. (canceled)